Management of acute variceal bleeding using hemostatic powder
Management of acute variceal bleeding using hemostatic powder
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DOI：
10.1177/2050640615570148
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发表时间：
2015-06-01
影响因子：
6
通讯作者：
Deviere, Jacques
中科院分区：
文献类型：
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作者：
Ibrahim, Mostafa;El-Mikkawy, Ahmed;Deviere, Jacques
背景和目标：本研究旨在测试Hemospray（R）的安全性和有效性，紧急控制急性静脉曲张出血（AVB）由于门静脉高压症patients.Patients和methods：这单臂，前瞻性试验，在比利时和埃及的两家医院进行，包括患者入院急诊室呕血和/或黑便和已知或怀疑肝硬化。所有患者均接受紧急血流动力学稳定、奥曲肽（50 mcg推注，然后25 mcg/h，持续24小时）和静脉注射头孢曲松（1 g/h）。在入院后6小时内进行内镜检查以确认AVB和Hemospray（R）应用（如有指征）。患者保持观察24小时，并进行第二次内窥镜检查和明确的治疗（带结扎和/或氰基丙烯酸酯注射在胃静脉曲张的情况下）的第二天。结果：38例患者入院怀疑AVB，其中30例已确认AVB（70%男性，平均年龄59.5岁（范围，32.0-73岁））。Child-Pugh C级肝病占53.4%。食管静脉曲张发生率为83.4%，胃静脉曲张发生率为10%，十二指肠静脉曲张发生率为6.6%。43.4%的患者在内窥镜检查时观察到喷射性出血。1例患者在应用Hemospray（R）后6小时发生呕血，并接受了紧急内镜下结扎带结扎术。结论：Hemospray（R）应用于急性房室传导阻滞患者的紧急治疗在短期随访中是安全有效的。
Background and objectives: This study aimed to test the safety and efficacy of Hemospray (R) for emergency control of acute variceal bleeding (AVB) due to portal hypertension in cirrhotic patients.Patients and methods: This single-arm, prospective trial, conducted at two hospitals in Belgium and Egypt, included patients admitted to the emergency room with hematemesis and/or melena and known or suspected liver cirrhosis. All patients received urgent hemodynamic stabilization, octreotide (50 mcg bolus then 25 mcg/hour for 24 hours) and intravenous ceftriaxone (1 g/hour). Endoscopy to confirm AVB and Hemospray (R) application (if indicated) was performed within six hours of admission. Patients were kept under observation for 24 hours and underwent second endoscopy and definitive therapy (band ligation and/or cyanoacrylate injection in cases of gastric varices) the next day.Results: Thirty-eight patients were admitted for suspected AVB, and 30 of these had confirmed AVB (70% male; mean age 59.5 years (range, 32.0-73 years)). Child-Pugh class C liver disease was present in 53.4%. Esophageal varices were observed in 83.4% of patients, gastric varices in 10%, and duodenal varices in 6.6%. Spurting bleeding at the time of endoscopy was observed in 43.4%. One patient developed hematemesis six hours after Hemospray (R) application and underwent emergency endoscopic band ligation. No major adverse events or mortalities were observed during 15-day follow-up.Conclusion: Hemospray (R) application was safe and effective at short-term follow-up for emergency treatment of AVB in cirrhotic patients.